Prevalence of Cutaneous Leishmaniasis in School Children in Bam and Barawat/Iran in 2006

Introduction: Cutaneous leishmaniasis is an important public health problem in many tropical and sub-tropical countries including Iran. In Iran, it presents in two forms of anthroponotic CL (ACL) and zoonotic CL (ZCL). Bam is one of the oldest foci of ACL and the earthquake of 2003 December, 26th made a significant change in the population and environmental factors and subsequently in epidemiological feature of the disease. The objective of this study was to assess the prevalence of CL in school children and treatment of patients. The results of this study can be used for prevention and planning future control programs in the district of Bam. Methods: The survey was conducted as a cross-sectional descriptive study during spring 2006. A total of 4931 children from 30 primary schools (6-10 years), elementary schools (11-14 years) and high schools (15-18 years) were selected randomly and examined physically in Bam and Barawat. The suspected CL cases were referred to the CL clinic. Smear scrapings were taken from the active lesions for direct microscopic examination and treatment of the confirmed cases. A questionnaire was completed for each case, indicating demographic and medical aspects. SPSS software was used for data entry and further analysis. The χ 2 test was used to determine any significant difference in disease prevalence. Results: In whole, 4.9% of the school children had active lesions and there was a significant difference between boys (6.3%) and girls (3.6%) in this regard (P<0.01). Lupoid lesions were significantly more in boys comparing to girls (80.9% versus 19.1%, P<0.005). The prevalence rate of scar in students was 14.9% and there was a significant difference in this regard between elementary schools children and the children in two other levels (P<0.05). In whole, 74.5% had one lesion, 17.3% had two lesions and 8.2% had three or more lesions. Hand was the most frequent site of involvement (47.8%), followed by face (33.8%), legs (14.9%) and other body parts (3.5%). Conclusions: The present study indicated that the epidemiological features of CL have changed significantly as compared to the previous reports. The main differences are higher prevalence rate of the disease, particularly in boys than girls and significant higher rate of lupoid lesions in boys rather than girls. Moreover, the number and location of lesions and the clinical features of thedisease have been changed significantly. These findings emphasize further researches on epidemiological aspects especially on causative agent, host and suspected accidental hosts for future planning and implementation of suitable control programs.